Term
Drug Nomenclature Chemical Name Generic Name Trade Name |
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Definition
Chemical Name = chemical composition and molecular structure. Generic Name = name assigned to the drug by the USAN council. Trade Name = A drug's registered trademark, use restricted to the owner of the patent. |
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The science of preparing and dispensing drugs, including dosage form design (eg tablets, capsules, injections, patches, etc.) |
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| The rate of drug distribution among various body compartments after a drug has entered the body. It includes the phases of absorption, distribution, metabolism, and excretion of drugs. |
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| The study of biochemical and phsiologic interactions of drugs at their sites of activity. It examines the physicochemical properties of drugs and their pharmacologic interaction with body receptors. |
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| Define Pharmacotherapeutics |
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Definition
| Focuses on the use of drugs and the clinical indications for administering drugs to prevent and treat diseases. It defines the principles of drug actions. |
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| Pharmacokinetics: Absorption |
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Definition
| Movement of a drug from its site of administration to the BLOOD STREAM where it is distributed to tissues. |
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| Pharmacokinetics: Bioavailability |
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Definition
| Refers to a term used to express the extent of drug absorption. |
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| Pharmacokinetics: What is the 1st pass effect? |
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Definition
| If the drug is metabolized in the liver or excreted in the bile, some of the active drug will be inactivated or diverted before it can reach the general circulation and its intended sites of action. |
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| If two drugs are bioequivalent, this means they are what what? |
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Definition
| When two drugs have the same bioavailability (extent of drug absorption) and same concentration of active ingredient, they are bioequivalent (eg. a brand-name drug and the same generic drug) |
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| Name factors affecting the rate of absorption |
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Definition
| Presence of food or fluids ingested with the drug, the dosage formulation, the status of the absorptive surface, the rate of blood flow to the small intestine, the acidity of the stomach, and GI motility. Also route of administration. |
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Definition
Hepatic Arterial Oral Portal Venous Rectal |
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Definition
Aural Buccal Inhaled Intraarterial Intramuscular Intranasal Intraocular Intravaginal Intravenous Subcutaneous Sublingual Transdermal |
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Definition
| Transport of durg by bloodstream to its site of action. |
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| Heart, Liver, Kidney, Brain |
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| Distribution in regards to protein... |
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Definition
| Drugs may bind to protein. Drugs can be freely distributed to extravascular tissue ONLY if NOT bound to Protein. If a drug is bound to a protein, it is generally too LARGE to pass into tissues. Unbound portion of drug is pharmacologically active and considered FREE. Wheras bound drug is pharmacologically INACTIVE. |
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| Distribution in regards to difficulty |
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Definition
| There are some sites in the body that are difficult to distribute a drug, such as those with poor blood supply like bone or have phsiological barriers that make it difficult for drugs to pass through. |
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| Metabolism: "Biotransformation" |
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Definition
- Refers to the biological transformation of a drug into an inactive metabolite, a more soluble compound, or a more potent metabolite.
- Cytochrome P-450 enzymes in the liver
- Influencing factors such as: Genetics, diseases, and the concurrent use of other meds.
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Term
| Barbituates have an increased or decreased drug metabolism? |
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Definition
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| Rifampin (P-450 inducer) has an increased or decreased drug metabolism? |
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Definition
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| Erythromycin (P-450 inhibitor) have an increased or decreased drug metabolism? |
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Definition
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| Ketoconazole (P-450 inhibitor) have an increased or decreased drug metabolism? |
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Definition
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Definition
Elimination of drugs from the body as parent, active, or inactive compounds. Primarily excreted by kidney, but also by LIVER and BOWEL. Excretion by the intestines is called BILIARY EXCRETION; drugs taken up by the liver, secreted into bile, and excreted in FECES. |
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Definition
| Definition: The initial metabolism in the liver of a drug absorbed from the GI tract before the drug reaches systemic ciruclation through the bloodstream. |
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| Most drugs are removed after how many half-lives? |
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Definition
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| The physiological state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose. |
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| Is the time it takes for the drug to elicit therapeutic response. |
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Definition
| The time it takes for a drug to reach its maximum therapeutic response. Peak is the highest blood level of a drug. |
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Definition
| Is the time that drug concentration is sufficient to elicit a therapeutic response. |
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| The lowest blood level of a drug |
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| Pharmacodynamics: 3 basic ways for Mechanism of Action |
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Definition
Receptor Interaction Enzyme Interaction Nonselective interaction |
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| Define Receptor interaction |
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Definition
| Drug receptor interaction entails the selective joining of the drug molecule with a reactive site on the surface of a cell or tissue. Most commonly, this site is a macromolecular protein structure within the cell membrane. This binding of the drug molecule to the receptor molecule in turn elicits a biologic effect. Therefore, a receptor can be defined as a reactive site on the surface or inside of a cell. ONce a drug binds to and interacts with the receptor, a pharmacologic response is induced. |
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Definition
| Drug-enzyme interaction occurs when the drug chemically binds to an enzyme molecule in such a way that alters (inhibits or enhances) the enzyme's interaction with its normal target molecules in the body. |
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Definition
| Drugs with nonspecific mechanisms of action do not interact with receptors or enzymes to alter a physiologic or biologic function of the body |
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Definition
| Often involves more intensive drug treatment and is implemented in the acutely ill or even the critically ill. It is often needed to sustain life or treat disease. Examples are the administration of vasopressors to maintain blood pressue and cardiac output after open-heart surgery, the use of volume expanders in a patient who is in shock, the use of antibiotics in a trauma patient at high risk of infection, and intensive chemotherapy for a pt. with newly diagnosed cancer. |
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Definition
| Maintenance therapy typically does not eradicate problems the patient may have but does prevent progression of a disease or condition. It is used for the treatment of chronic illnesses such as hypertension. In the latter case, maintenance therapy maintains the patient's blood pressure within given limits, which prevents certain end-organ damage. Oral contraceptives is an example of maintenance therapy. |
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Definition
| Supplemental or replacement therapy supplies the bodhy with a substance needed to maintain normal function. This substance may be needed either because it cannot be made by the body or because it is produced in insufficient quantity. Examples are the administration of insulin to diabetic patients and of iron to patients with iron-deficiency anemia. |
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Definition
| Goal here is to make the patient as comfortable as possible. It is typically used in the end stages of an illness when all attempts at curative therapy have failed. Examples are the use of high-dose opioid analgesics to relieve pain in the final stages of cancer and the use of oxygen in end-stage pulmonary disesase. |
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Definition
| Maintains the integrity of body functions while the patient is recovering from illness or trauma. Examples are provision of fluids and electrolytes to prevent dehydration in a patient with influenza who is vomiting and has diarrhea, and administration of fluids, volume expanders, or blood products to a patient who has lost blood during sugery. |
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Definition
| Drug therapy provided to prevent illness or other undesirable outcomes. Ex. Surgeion administering an antibiotic before making the incision. |
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Definition
| Has no scientific basis but instead is based on experience. It is the administration of a drug when a certain pathologic process is suspected based on the patient's symptoms because the drug has been found in the past to be beneficial in such cases. Eg. pt given acetaminophen when s/he has a fever. |
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Definition
| One must always keep in mind that pts may sometimes experience less common, and therefore less readily identifiable, adverse drug effects. The nurse should consult comprehensive references, pharmacists, or poison and drug information center staff wherever there is uncertainty regardng adverse effects that a patient may be experiencing. |
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Definition
| The ratio of a drug's toxic level to the level that provides therapeutic benefits. The safety of a particular drug therapy is determined by this index. |
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Definition
| Means that the difference between a therapeutically active dose and a toxic dose is small. This type of drug has a greater likelihood of causing an adverse reaction, and therefore its use requires closer monitoring. Eg. Warfarin and digoxin. |
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Definition
| An important tool for evaluating the clinical response to drug therapy. Certain drug levels are associated with therapeutic responses, whereas other drug levels are associatted with toxic effects. Toxic drug levels are typically seen when the body's normal mechanisms for metabolizing and excreting drugs are compromised. |
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Definition
| Another patient-specific factor to be considered when monitoring drug therapy is the patient's concurrent diseases or other medical conditions. A patient's response to a drug may vary greatly depending on physiologic and psychologic demands. |
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Definition
| The monitoring of drug therapy requires a knowledge of tolerance and dependence and an understanding of the difference between the two. Tolerance is a decreasing response to repeated drug doses. |
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Definition
| Dependence is a phsiologic or psychologic need for a drug. |
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Definition
| The more drugs a pt receives, the more likely a drug interaction will occur. A big problem w/elderly. Leads to "prescribing cascade" in which an elderly pt develops adverse effects from one or more of the meds he/she is taking and the health care provider then precribes yet another drug which creates the potential for even more adverse effects. |
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Definition
| Effects caused when 2 drugs with similar actions are given together. |
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Definition
| Effects caused when 2 drugs given together result in an effect greater than the sum of effects for each drug given alone. |
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Definition
| Caused when 2 drugs given together result in an effect less than the sum of effects of each drug alone. |
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Definition
| Two parenteral drugs/solutions mixed together resulting in chemical deterioration of 1 or both drugs. Produces a precipitate or haziness. |
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Definition
| preventable situation that can occur in ALL PHASES of drug therapy. |
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Definition
| Unexpected and undesirable drug reaction that occurs at therapeutic drug doses. Not all ADR's are preventable. |
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Definition
An extension of the drug's normal effects in the body. Eg. blood pressure med causing BP to drop to the point pt goes unconscious. Includes adverse effects which are predictable, well-known ADR's resulting in minor or no changes in patient management. |
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| Allergic (hypersensitivity) Reaction |
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Definition
| Immunologic hypersensitivity reaction resulting from an unusual sensitivity of a pt. to a particular med. A type of ADE and a subtype of ADR. |
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Definition
| An abnormal and unexpected response to a medication, other than an allergic reaction, that is pecululiar to an individual patient. |
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Definition
| Teratogenic effects of drugs or other chemicals results in structural defects in the fetus. Viral diseases such as measles and radiation can also have teratogenic effects. Prenatal development involves a delicate sequence of interrelated embryologic events. Any significant distruptions of embryogenisis can have a teratogenic effect. |
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Definition
These are permanent changes in the genetic composition of living organisms and consists of alerations in chromosone structure the number of chromosones, or the genetic code of the DNA molecule. Radiation viruses chemicals and drugs can all act as mutagenes in humans. |
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Definition
| Theses are cancer causing effects of drugs, other chemicals, radiation, and viruses. Entities that produce such effects are called carcinogens. Ex: smoking, evironmental polution, drug abuse, and diet. |
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Term
Lifespan considerations: DRUG THERAPY DURING PREGNANCY |
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Definition
Fetus is exposed to many of the same substances as the mother. Period of greatest danger for drug-induced developmental defects is 1st trimester. Factors affecting drug transfer: Drug properties, i.e. molecular weight, protein binding
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Term
Fetal gestational age. When during pregnancy does the greatest amount of maternal drug get to the fetus? |
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Definition
| Drug transfer to the fetus is more likely during the last trimester. This is the result of enhanced blood flow to the fetus, increased fetal surface area, and increased amount of free drug in the mother's circulation. |
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Term
Factors affecting drug transfer: Maternal factors, i.e. kidney and liver fx, G6PD disease |
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Definition
| The lack of certain enzyme systems, as seen in the pharmacogenetic disease glucose-6-phosphate dehydrogenase deficiency, may result in adverse drug effects to the fetus when the mother is exposed to a drug that is normally metabolized by this enzyme, including the commonly used over-the-counter (OTC) drug aspirin. |
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| Pregnancy Safety Categories (5), from Category A (no risk to fetus) to X (positive evidence of human fetal risk) |
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Definition
Category A
Studies indicate no risk to human fetus.
Category B
Studies indicate no risk to animal fetus; information for humans is not available.
Category C
Adverse effects reported in animal fetus; information for humans is not available.
Category D
Possible fetal risk in humans reported; however, consideration of potential benefit vs. risk may, in selected cases, warrant use of these drugs in pregnant women.
Category X
Fetal abnormalities reported and positive evidence of fetal risk in humans available from animal and/or human studies. These drugs should not be used in pregnant women.
Know range, but not the studies of these categories
Studies indicate no risk to human fetus.
Category B
Studies indicate no risk to animal fetus; information for humans is not available.
Category C
Adverse effects reported in animal fetus; information for humans is not available.
Category D
Possible fetal risk in humans reported; however, consideration of potential benefit vs. risk may, in selected cases, warrant use of these drugs in pregnant women.
Category X
Fetal abnormalities reported and positive evidence of fetal risk in humans available from animal and/or human studies. These drugs should not be used in pregnant women.
Know range, but not the studies of these categories
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Term
| DRUG THERAPY DURING BREASTFEEDING |
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Definition
Great number of drugs can cross from mother’s circulation into breast milk.
Are drug levels higher or lower than in maternal circulation? lower
Risks vs. benefits again must be considered on case-by-case basis. |
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Term
CONSIDERATIONS FOR NEONATAL & PEDIATRIC PATIENTS Absorption |
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Definition
- Gastric pH is less acidic because acid-producing cells in the stomach are immature until approx 1-2 yrs of age.
- Gastric emptying is slowed b/c of slow or irregular persitalsis
- Firs-pass elimination by the liver is reduced b/c of the immaturity of the liver and reduced levels of microsomal enzymes.
- IM absorption is faster and irregular.
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CONSIDERATIONS FOR NEONATAL & PEDIATRIC PATIENTS Distribution |
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Definition
- Total body H2O is 70-80% in full-term infants, 85% in premature newborns, and 64% in children 1-12 yrs old.
- Fat content is lower
- Protein binding is decreased
- Immature blood brain barrier
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CONSIDERATIONS FOR NEONATAL & PEDIATRIC PATIENTS Metabolism |
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Definition
- Decreased microsomal enzymes
- Older children may have increased metabolism and require higher doses once hepatic enzymes are produced.
- Many variables affect metabolism in premature infants, infants and children, including the status of liver enzyme production, genetic differences, and what the mother has been exposed to during pregnancy.
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CONSIDERATIONS FOR NEONATAL & PEDIATRIC PATIENTS Excretion |
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Definition
Glomerular filtration rate and tubular secretion and resorption are all decreased b/c of kidney immaturity Perfusion to the kidneys may be decreased and results in reduced renal function, concentrating ability, and excretion of drugs. |
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Term
Pharmacodynamics Are all drugs more toxic in children than adults? |
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Definition
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Term
Pharmacodynamics Do we always give lower doses to children? |
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Definition
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Term
Pharmacodynamics Are all drugs contraindicated in growth years? |
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Definition
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Term
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Definition
Many drugs commonly used in adults have not been studied in children, and therefore are administered on an empirical basis.
Dose calculations using the body surface area (BSA) nomogram are most accurate.
If calculated dosage causes concerns or varies from safe range, DO NOT GIVE IT! |
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Term
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Definition
See Brad Huit. Ha ha, just kidding Brad... Pertaining to a person who is 65 years of age or older. |
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| Polypharmacy and Drug Use |
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Definition
Elderly take MANY drugs, OTC and prescription
Drug therapy in this population is more likely to result in drug interactions, adverse effects, and hospitalization. Why?
Polypharmacy leads to what is known as the “prescribing cascade,” in which an elderly patient develops adverse effects from one or more of the medications he or she is taking and the health care provider then prescribes yet another drug, which creates the potential for even more adverse effects. The risk of drug interactions, adverse effects, and potentially a hospitalization (possibly prolonged) is far greater in this situation. As the number of medications a person takes increases, so does the risk of drug interaction. |
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| Physiologic Changes/Pharmacokinetics |
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Definition
In general absorption is increased or decreased? decreased
Distribution: Some drugs may have higher concentrations in elderly than younger patients. Why? Distribution, metabolism and excretion are lowered.
What happens to metabolism? Increased or decreased? decreases
Excretion is decreased due to decreased glomerular filtration rate. |
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| Implementing the 5 rights will prevent all medication errors. TRUE OR FALSE? |
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Definition
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| Who can be involved in med errors? |
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Definition
Anyone involved in the prescribing, filling, or administering meds.
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Term
| Are med errors preventable? |
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Definition
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Term
PSYCHOSOCIAL ISSUES THAT CONTRIBUTE TO ERRORS
Organizational Issues |
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Definition
One 2003 study showed that ½ of all preventable ADRs occurred when? When it was prescribed
Collaborating relationships critical!
Technology, such as_computerized prescriber order entry and bar coding of medication___ reduces errors. |
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Educational System Issues and their Impact on Medication Errors
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Definition
Health care professionals have a tendency to feel denial, fear, or shame when wrong.
NO QUESTION is a stupid question … ask your clinical instructor! |
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| Medication Errors and Related Sociologic Factors |
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Definition
| Quality of nurse-physician communication is a strong predictor of patient outcomes … related to medication errors. |
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| Medication Reconciliation |
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Definition
Defn: procedure that seeks to prevent medication errors through the ongoing assessment and updating of every patient’s list of medications throughout the health care process and timely communication of such information to both patients and their providers; involves 3 steps which should be repeated at each stage of health care delivery:
Verification:
Clarification: Professional review (you!)
Reconciliation:
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Term
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Definition
We are obligated to notify patients when errors have been made.
Whistle-blowing refers to a disclosure that is made outside of the health care facility to a regulatory or investigative agency or to the public re: a patient care error.
As nurses, we are required to ‘blow our whistle’ to be consistent with The Code of Ethics.
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POSSIBLE CONSEQUENCES FOR NURSES |
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Definition
Emotional toll
Required continuing training
Suspension or termination
Discipline by the state board of nursing
As a student, if you make an error, notify your clinical instructor IMMEDIATELY |
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